Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery

Author:

Tapela Neo M.1,Mpunga Tharcisse1,Karema Nadine1,Nzayisenga Ignace1,Fadelu Temidayo1,Uwizeye Frank R.1,Hirschhorn Lisa R.1,Muhimpundu Marie Aimee1,Balinda Jean Paul1,Amoroso Cheryl1,Wagner Claire M.1,Binagwaho Agnes1,Shulman Lawrence N.1

Affiliation:

1. Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye,...

Abstract

Purpose The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science—the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed—is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. Methods The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. Results Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. Conclusion Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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